'Redistricting' Considered for Liver Donor Maps

Researchers report that the existing distribution model of organs for liver transplants is unbalanced and depends upon longstanding relationships among medical centers. Organ donor advocates are calling for a change in the allocation process.

David C. Mulligan, MD

Organ donor advocates want to copy the mathematical formulas that draw boundaries for political maps and zoning districts and use them to create a more equitable allocation of transplanted livers from deceased donors.

"Currently the geographic disparity for access to livers in this country is great," says David C. Mulligan, MD, director of Surgical Transplantation at Mayo Clinic Hospital in Phoenix, AZ. "We need to find better ways to improve our system of allocation to reduce this disparity so that in the end, access to liver transplants will be the same or as close to the same as possible no matter where you live in this country."

Geography can mean the difference between a 10% – 90% chance of dying while on a waiting list for a donor liver, researchers say. "The existing system is based on the geography of where a handful of centers that were performing liver transplantation were located," says Mulligan, who is also chair of the liver committee for the Organ Procurement and Transplantation Network/United Network for Organ Sharing.

Researchers at Johns Hopkins University School of Medicine reported this month that the existing "unbalanced" distribution model depends upon the longstanding relationships among medical centers.

Mulligan agrees.

"When liver transplantation was first developed in this country, the transplants were done at a handful of centers, five or six centers started the whole process," he says. "They were distributed across the country from Pittsburgh and Dallas and Los Angeles and Omaha NE so each of these programs as they were beginning to develop needed to try to determine where organs could potentially come from."